P936: EXPLORING HETEROGENEITY IN TREATMENT PREFERENCES OF PATIENTS WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA IN THE UNITED STATES, UNITED KINGDOM, FRANCE, SPAIN, ITALY AND GERMANY
Authors: Rakesh Popat, Sikander Ailawadhi, David Kleinman, Sue Perera, Boris Gorsh, Caitlin Thomas, Sarah Mulnick, Oneill Alicia, Melissa Ross, Maya Hanna, Alexa Molinari, Heather Gelhorn
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: The advent of novel treatment options for relapsed/refractory multiple myeloma (RRMM) with differing administration (admin), and efficacy/safety profiles, necessitates an understanding of the relative importance of treatment attributes to patients (pts), and the trade-offs they are willing to make when considering treatment options. Aims: To explore heterogeneity in pt preferences for RRMM treatment. Methods: Adults with RRMM who had progressed on ≥2 lines of therapy (LOT) from the US, UK, Italy, Germany, France, and Spain completed an online discrete choice experiment (DCE) with the following attributes: overall response rate (ORR), overall survival (OS), duration of response, peripheral neuropathy (PN), ocular adverse events (OAEs), cytokine release syndrome (CRS), severe diarrhea, and admin. A latent class logit model was used to identify if different preference patterns coexisted in the sample. A multivariate model compared differences in personal characteristics between groups. Relative attribute importance scores were also calculated and pt willingness to trade-off between attributes was assessed. Results: In total, 296 pts completed the DCE. Median (range) age was 65 (38–85) years, 52% were male, and pts had received median (range) of 3 (2–8) prior LOT. Four groups of pts with distinct preference patterns were identified: ORR maximizers (n=107, 36%), OS maximizers (n=82; 28%), OS and ORR maximizers (n=62, 21%), and ORR maximizers preferring IV/SC treatment (n=45, 15%) (Figure). Across all groups, increasing efficacy had the greatest influence on treatment preference. However, the relative importance of treatment attributes varied. ORR maximizers were more likely to have mild-to-moderate cancer symptoms than other groups at the time of DCE completion, were more concerned with avoiding PN, and preferred IV/SC admin (+/- oral pills) over CAR-T therapy admin procedures. OS maximizers had progressed quicker (diagnosed 2–5 years ago, 5+ LOT) and were less concerned with PN risk than other groups. OS and ORR maximizers had less severe overall cancer symptoms than other groups at the time of DCE completion, made decisions that were influenced more evenly between increasing OS and ORR, and were more concerned with avoiding CRS than other groups. ORR maximizers preferring IV/SC treatment were less likely to be in response, and more likely to be on 2 or 3 LOT compared to other groups at the time of DCE completion; they also cared most about admin and least about risks of side effects. Willingness to trade-off increased risks of side effects for improved OS and ORR also significantly varied between groups. To tolerate a 50% risk of PN, a 60% risk of OAEs, and a high risk of CRS, ORR maximizers would need 28.6, 9.8, and 16.3 mo increase in OS, respectively, and OS and ORR maximizers a 6.5, 5.8, and 12.1 mo increase, respectively. OS maximizers would require a 4.6 and 5.3 mo increase in OS to tolerate a 60% risk of OAEs and a high risk of CRS, respectively. ORR maximizers preferring IV/SC treatment were willing to tolerate these increased risks without an increase in OS. Summary/Conclusion: Heterogeneity observed in treatment preferences allowed pts to be stratified into 4 groups with distinct preference patterns. While all groups prioritized maximizing efficacy, the relative importance of attributes varied across groups. Given the varied treatment priorities identified, this study highlights the need for shared decision-making in RRMM to ensure pts receive treatment that aligns with their preferences. Funding: GSK (212408)Keywords: Multiple myeloma, Patient, relapsed/refractory